Cystic Fibrosis Research and Translation Center
Cystic Fibrosis Research and Translation Center
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Core Services Request Form

  Required Information
Date:
First Name:
Last Name:
Department:
Box #:
Telephone:
Email:
Project Title:
Project Description (include hypothesis, specific aims and brief description):
Other Collaborators or Co-Investigators on the project:
Relevance to Cystic Fibrosis:
  Administrative Information
IRB #:
Approval Period:
IACUC #:
Approval Period:
Funding Source:
Other Source:
Grant / Contract#:
PI / PD:
Same as Requestor? Yes No
Annual Directs:
Start Date:
End Date:
  Core Services Requested
Microbiology Core? Yes No

Genomics Core? Yes No

Inflammation Core? Yes No

Clinical Core? Yes No

  Complete Form
Proposed Use/Comments:


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